Diabetic ketoacidosis, also called DKA, occurs when you don’t have enough insulin. It is mostly a problem for people with type 1 diabetes. A person with diabetes may have such low levels of insulin that his or her liver may produce unchecked levels of glucose and ketones, especially during illness or stress. It can occur in people with type 1 diabetes who have not yet been diagnosed.

Diabetic ketoacidosis can start innocently enough; you miss a dose of insulin, the insulin you’ve been using has gone bad, or your insulin pump tubing gets blocked. The lack of insulin leads to an undetected high blood glucose level, which can progress to a coma, shock, pneumonia, difficulty breathing, and even death.

Diabetic ketoacidosis can occur during periods of stress or illness, when the body releases hormones that promote the release of stored glucose and block the effects of insulin. Sometimes when you are sick and can’t eat, you may think, “I shouldn’t take insulin today.” But your body still needs insulin to cover its 24-hour insulin needs, even if you aren’t eating. Plus, you are likely producing extra glucose. So, in addition to your usual dose of insulin, you may actually need extra insulin. Drinking plenty of fluids will also help. Talk with your health care providers ahead of time about a plan of action for dealing with ketoacidosis and how to prevent it when you are stressed or ill.

People with diabetes are more susceptible to wounds because diabetes can affect blood vessels, making them not work as well. Wounds need blood to heal, so decreased blood flow can make wounds hard to heal. Also, people who have diabetes for a long time can develop damaged nerves. As a result, they can injure a foot and not know it because the nerves no longer work to tell them there is pain. With no pain, a person can keep walking on that foot, making it difficult to heal.

When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, end-stage renal disease (ESRD), is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).

Diabetes can increase your risk of heart disease and heart attack. In this video, Ronald Tamler, MD, clinical director of the Mount Sinai Diabetes Center, discusses the connection between the two diseases.

You can prevent heart disease even if you have diabetes by adopting good lifestyle habits. The first step? If you smoke, stop. Second, meet with a dietitian to create a meal plan that is high in fiber, low in saturated fat and trans fat, and that may help you lose weight if you need to. Try to exercise at least 30 minutes every day and build more activity into your day by using the stairs instead of the elevator, avoiding drive-throughs and parking further from your destination so you can walk more. Keeping your diabetes under control will also help minimize your risks for heart disease. Consult your doctor for more ways you can keep your heart healthy.

Sex is an important part of life and relationships. But diabetes can affect a man's sex life. It is important to understand that there is not just one reason a man with diabetes might be experiencing sexual health issues.

Erectile Dysfunction: Don't be afraid to talk with your doctor about impotence, also called erectile dysfunction or ED.

Low Testosterone: Take the Androgen Deficiency in the Aging Male (ADAM) questionnaire to assess your likelihood of having low testosterone, which often goes undiagnosed.

Gastric bypass surgery has been shown to improve or resolve type 2 diabetes mellitus in a large proportion of patients. The exact cause of this outcome is still under investigation, but has been attributed to a number of factors. Initially, the improvement of diabetes with gastric bypass surgery was thought to be secondary to the associated weight loss that is achieved. However, many patients saw improvements far earlier than that which could be explained by weight loss alone. In fact, patients were able to leave the hospital after surgery on a much lower medication regimen than their pre-operative regimen. Research in this field has shown that the gut hormones of patients who undergo bariatric surgery is changed compared to those who do not. Although the exact mechanism for this improvement has yet to be identified, we believe that the change in the hormonal milieu is at least in part the reason for this outcome. This remains to be an exciting field within surgery with much ongoing research.

Many foot amputations could be avoided if people with diabetes did a better job of controlling their blood glucose levels. That’s the conclusion of a recent study led by podiatrist Jason Hanft, DPM, who worked with epidemiologists at Harvard and podiatry residents at South Miami Hospital in comparing the healing time for foot wounds with blood glucose levels in 500 patients.

Dr. Hanft concluded that for every 1% increase in A1C levels, there was a 3% slower healing rate in diabetic foot wounds. (A1C is a blood test that measures average blood glucose levels over a three-month period.) “That means someone with an A1C level of 8 will heal much more slowly than someone with an A1C of 6,” says Dr. Hanft. He is the medical director of the podiatry residency program at South Miami Hospital and also on the staff at Baptist Hospital.

“The study shows that it is more important than ever for people with diabetes to get their blood sugar under tight control,” Dr. Hanft says. He says that doctors usually begin treating out-of-control blood sugar levels with moderate means, such as diet and pills, and move to insulin only when all else fails. But after seeing how high blood sugar impairs wound healing, he now feels that doctors should be more aggressive. “When test results are elevated, this should be viewed as an urgent problem that requires immediate intervention using the most intensive therapies available,” he says.